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Physician adoption
General
Critically important for the success of CPOE. It is affected by presentation of orders and information. The challenge is to get everyone on board especially those who use different systems and who work in different ways.
For CAHs, you want to keep the physicians who have been there for a while and do not wish to chase them away. However it really comes down to strong leadership with everyone on board.
Optimizing System access
Access
Single sign-on
Plenty of workstations
Appropriately configured workstations
Well maintained with fast processors / network and ample memory
Remote access
Point of care strategy
giving the physican easy access each time they need to use a workstation
Choices in devices
wired / Wireless
Computers on wheels / iPad
Discussion of the pros and cons of the different tools
Quiet working areas for chart review / data entry
Hospitalists have a different need - especially need a quiet zone for their dictations and entering orders, pacs, They also tend to fine a quiet place from which they will do most of their work
Training
Dedicated physician trainer that also provides support
Residents have been trained in groups - more comfortable that way
Attendings are trained one-on-one. Especially during the early days 2 - 4 hours anytime any day away from the unit and away from the practice. Office managers will help arrange times. Needs to be trained on their specialty need.
Support
Robust plan that includes trainers superusers 24x7 helpdesk who are qualified to answer physician questions with fast replies / answers
24x7 Needs to be in person during implementation (command center mentality) May back off when other users are available to provide support.
Prompt response to requests for change. Avoiding the black-hole syndrome. With reasons for the change / no change that closes the loop.
Involvement with the implementation
Working with the providers throughout the build helps them attain ownership
Communication
Building the burning platform - see communication - why we are doing this
Evidence that CPOE improves quality safety etc.
Be truthful about how it will not save time.
However, pre and post shadowing showed quicker turn around time in orders.
Bring in advocates / peers from other departments to meet with them and see how it can work for them
Policies
that suport adoption - will you permit the use of verbal orders. Important to support nursing so they do not feel like they are going to have an increase of work / verbal orders. If not it can be a barrier for nursing to support CPOE. Expectation that VO are only for ungency orders. TO is where there is no access to computer systems.
Policy for alerts that occur during entery of VO / TO. Suggestion VO - Pharmacy TO - doc stays on the phone.
Metrics
On adoption
on verbal orders
Tools
"A Structured Approach to Physician Adoption of Technology" Barbara A. Crowell, Dearborn Advisors, LLC http://www.dearbornadvisors.com/docs/Phys_Adopt_crowell.pdf
"Improving Physician Adoption of CPOE Systems" Scott R. Fisher, M.D.; Jean-Paul Creusat, M.D.; D. Andrew McNamara, M.D. Clinical Consulting Services, McKesson Provider Technologies
Top 10 Hospital-Physician Health IT Engagement Strategies
Edna Boone, HIMSS, Ben Brown, KLAS and William Young,Berkshire Health Systems
Studies
A Time-Motion Study to Evaluate the Impact of EMR and CPOE Implementation on Physician Efficiency
Amen A. Amusan, PMP, MS; Scott Tongen, MD; Stuart M Speedie, PhD; and Andrew Mellin, MD, MBA, Journal of Healthcare Information Management — Vol. 22, No. 4
Stories
Decrease in mortality associated with physician order entry system
- Researchers at Lucile Packard Children's Hospital and Stanford University School of Medicine have shown for the first time that a significant decrease in hospital-wide mortality rates can be associated with implementation of a computerized physician order entry system. Pediatrics 2010 Jul;126(1):14-21
How to implement CPOE successfully at your Hospital by John Halamka, MD
You've Led the Horse to Water, Now How Do You Get Him to Drink: Managing Change and Increasing Utilization of Computerized Provider Order Entry
Donald Levick, MD, MBA, Harry F. Lukens, and Paula L. Stillman, MD, MBA, Journal of Healthcare Information Management — Vol. 19, No. 1